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CHP detects a case of NDM-1 producing Enterobacteriaceae
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     The Public Health Laboratory Services Branch (PHLSB) of the Centre for Health Protection (CHP) has identified a case of New Delhi metallo-]-lactamase 1 (NDM-1) producing Enterobacteriaceae in a patient from India.

     The patient, a 54-year-old Indian lady who was hospitalised in India for subdural haematoma for about three months from May 2010, came to Hong Kong on December 15. She was admitted to Princess Margaret Hospital on December 17 for respiratory distress.  

     A strain of E. coli harbouring NDM-1 was detected from her rectal swab. No outbreak was detected in the ward. Her home contacts were asymptomatic.
  
     A spokesman for CHP said it is likely to be colonisation as the patient showed no active signs of infection. Investigations are underway and there is presently no sign of spread.

     This is the second detection of NDM-1 producing Enterobacteriaceae in Hong Kong.  The first case involved a 66-year-old man in October 2009. The patient has fully recovered.

     The spokesman explained that NDM-1 is an enzyme which can inactivate carbapenems and other beta-lactams such as penicillins. Bacteria harbouring this NDM-1 gene are commonly resistant to multiple antimicrobials, limiting therapeutic options and rendering severe clinical infections difficult to treat.  Most bacteria with the NDM-1 enzyme remain susceptible to two types of antibiotics, colistin and tigecycline.

     Infections have varied from being mild to potentially life threatening or fatal.  The level of risk depends on which part of the body is affected by the infection, and the general health of the patient.

     NDM-1 producing Enterobacteriaceae was first reported in a Swedish patient of Indian origin who travelled to New Delhi, India, in 2008. The first fatal case was identified in 2010 in a patient who received medical treatment in Pakistan before being repatriated to Belgium.  

     The NDM-1 producing Enterobacteriaceae has now been reported in many countries and regions, including Australia, Austria, Canada, Belgium, France, Germany, Japan, the Netherlands, Norway, Oman, Sweden, Singapore, Taiwan, the UK and the USA. Most patients have had prior hospital contact in the Indian subcontinent.

     The spokesman said that proper use of antibiotics and personal hygiene, especially hand hygiene, were important for the prevention of emergence and cross transmission of NDM strains.

Ends/Thursday, December 30, 2010
Issued at HKT 16:55

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